HomeMy WebLinkAboutOld England Loop (2)' CITY OF SANFORD PERMIT APPUCATION
A plica tion
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Submittal Date: -7 /07
En�^��nm
Parcel,H):� /(0— -�t5 Plr--CX'�M-Q�
zoning: Historic District:
Description of Work:
Square Footage:
J, P tly Mechanical 13 Plumbing 0 Fire Sprinkler/Alann 13 Pool 13 Sign 13
ermi pe, Building Electrical 13
Electrical: New Service of ANTS
Addition/Alteration 0 Change of Service E3 Temporary Pole 0
nitial 13 on
Mechanical': Reside! N -kesidential El
Replacement 0 New 13, (Duct Layout & Energy Calc. Required)
,
# of Gas Lines
- ' -.-Occupancy ��6=Residential [] Commercial []
' 'industrial o Occupancy Use Group(s):
Construction Type: �#of Stories:
#of Dwelling Uobo ______ Flood Zone: _____(FEMA form required)
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',Add Address: ply-AtAcb 6��hw-2
P4Q;�-')�State License Number:
Mortgage Lend
Pond," arnpany
S.
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Architect/Engineer: Phone: -7 93(`\
Plan Review Contact e o o Fax: E-maili Z C,
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no Work or installation has commenced priorto the
issuance of a permit and that 0 work will be performed to meet standards of all laws regulating construction in this jurisdiction. I understand that a separate
permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS� and
AIR CONDITIONERS, etc.
OWNER'S AFFIDAVIT- I certify that all of the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMM[ENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR INTROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING; CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE-OF-CON&IENCEMENT.
the'requifements of erm ere may a itidnal restrictions app icable to this property that may o
NOTICE: In addition
this county, and there may be additional permits required from other governmental entities such as water management districts� state agencies, or federal agencies.
Acceptan�c of permit verific thp requirements of Florida Lien Law, F
I& mo Dee
�na Sigfiature of Contractor/Agent
~
Wo�� Public ~
En�^��nm
�-!Iic*mm&3ion DD451507
--
iier/Agent is X— Personal ly'Known to Mc,or
11)
�----_-=-�
APPROVALS: ZONING:
.Special Conditions:
Rev 02/2007
ent's Name
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Date Signature of Notary -State of Florida Date
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IRES: February 23,2011
Contractor/Agent-- Co.
0 �
Produced ID
nTu:_rn ENG: / ^ ''
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POWER OF ATTORNEY
Date: 611(,(0:
do hereby authorize7if¢�
to pull the e?14 Lp� ►� permit for Q(.b C—(` �� ( P— I! Gpc-). i
Type of permit
Signature
qQg
State of Florida
County of `em, ad -E'_
otary
Personally known to me or produced ID
on _� _ day of , �„ , 20_C�
job address
P4�, NATHALIFERNANDEZ
p&VOMMISMON A DD454
FJtPIRFS:
31. 2MM
a F1 Not at A°0C. Ca
Ialllt•}-NOTARY